# ASQ:SE2

## Factors to Consider Before Beginning the Referral Process

| Factors to consider before referral | Sample questions | Examples of follow-up action options |
| --- | --- | --- |
| **Setting/time** | Does the child act the same way at home and in child care or preschool? (i.e., Is the behavior consistent across settings?) How long has the problem behavior been occurring? | Have another caregiver complete ASQ:SE-2 to determine the consistency of behavior across settings. If the child's behavior is not consistent, consider developing a behavior support plan in the setting where the behavior is problematic. |
| Is the setting new or unfamiliar to the child or family? | Analyze caregiving environments to determine in what ways the environment is supporting or compromising the child's positive behaviors. |  |
| Is the setting a good match for the child's temperament (e.g., large versus small child care settings)? | Provide parenting support and education to the parent in the home environment. |  |
| Where, when, and under what environmental conditions does the behavior occur? | Conduct a functional behavioral analysis (Dunlap et al., 2014) to determine the function of the behavior for the child. Use the results to create a positive behavior support plan for the child. |  |
| Is the child being reinforced for this behavior or gaining access to reinforcers, such as preferred foods or activities, special time with a parent or teacher, or time alone? | Refer the child for an early childhood behavioral or mental health evaluation if concerns persist. |  |
| **Development** | Is the behavior related to a developmental stage? Are individual factors (e.g., temperament) related to the child's behavior? | Provide developmental information (e.g., ASQ:SE-2 Social-Emotional Development Guides and Activities), positive behavior management suggestions, and so forth. |
| Can the behavior be attributed to a developmental delay or a sensory processing disorder? | Screen the child using a developmental screening tool such as ASQ-3. |  |
| Are the child's skills at age level in the following domains? Fine and gross motor, Cognitive/problem solving, Personal-social, Expressive and receptive communication | Refer the child to local Part C (early intervention) or Part B (early childhood special education) agency if concerned and/or if developmental screening tool indicates a need for further evaluation. Refer the child for an early childhood behavioral or mental health evaluation if concerns persist. |  |
| **Health** | Is the child's behavior related to health or biological factors? | Refer the child to his or her primary health care provider. Address behavior of concern to determine if there is a biological/medical cause, and make referrals or provide follow-up as indicated within the health system. |
| Has the child had a recent medical checkup? | Keep in close contact with the family's regarding all aspects of the child's health. |  |
| Have the following been considered as behavioral influences? Lack of sleep or hunger, Medications or allergies, Exposure to drugs in utero | Refer the child for an early childhood behavioral or mental health evaluation if concerns persist. |  |

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| **Family/culture** | What is the child's home (native) language? | Determine if language or translation issues may be influencing parent responses to items (e.g., misunderstanding the intent of items). |
| --- | --- | --- |
| Is the "problem" behavior within the cultural norm for this child's family? | Talk to family members about the behavior and whether they consider it to be problematic. Work with the family to determine appropriate follow-up action. |  |
| Is the parent-child relationship influencing the child's ASQ:SE-2 results? |  |  |
| Has the child been affected by stressful or traumatic events (ongoing, past, or present)? | Seek advice from community health workers or “cultural brokers” to determine if the behavior is within the cultural “norm.” |  |
| • Has the child witnessed violence in the home or in the community? |  |  |
| • Has the child been involved in abusive or neglectful situations? |  |  |
| • Has the child recently been moved from his or her home? |  |  |
|  | Are there family issues that are stressful (e.g., parent mental health issues, drug and alcohol issues)? | Use a professionally administered parent-child interaction measure. Support the parent's understanding of responses to the social-emotional needs of the young child. If necessary, refer the child to early childhood mental health specialists to assess needs and provide therapeutic services to the parent-child dyad. |
|  |  | If the child recently has moved to a new caregiving environment that is safe and nurturing, it may be appropriate to wait a short time before referring. |
|  |  | If the child is in an unsafe or neglectful environment refer to child protective or other services. |
|  |  | Refer the child for an early childhood behavioral or mental health evaluation if concerns persist. |
| **Parent concerns** | Did the parent or caregiver express any concerns about the child's behavior? | Obtain more information from the parent or caregiver about any concerns noted on ASQ:SE-2; ask, "Can you tell me more about?" |
| What is the intensity and frequency of the behavior of concern? | Provide developmental information (e.g., ASQ:SE-2 Social-Emotional Development Guides and Activities, ASQ:SE-2™ Learning Activities), parenting education or support, and so forth. |  |
| Is the behavior of concern typical or atypical given the child's developmental stage? |  |  |
| Are individual factors of parent or child (e.g., temperament) related to the parent's concern about the child's behavior? | Listen carefully to all parent concerns. Support the parent in identifying and accessing resources and supports within the community to address any priority concerns (e.g., support agencies to access basic needs such as housing/food, quality child care, respite care, drug/alcohol counseling, adult mental health counseling). |  |
|  | Refer the child for an early childhood behavioral or mental health evaluation if concerns persist and are atypical for the child's age. |  |

Excerpted from the Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASQ:SE-2™) User’s Guide, Squires, Bricker, & Twombly. © 2015 Paul H. Brookes Publishing Co., Inc. All rights reserved.